Pancreatic Cancer Treatment and Research Advances Offer Reason for Hope

July 30, 2007 — Gastrointestinal surgeon Steven Strasberg, MD, discusses research into the causes and treatment of pancreatic cancer and other forms of cancer offers hope for greater gains in the fight against pancreatic cancer in the near future.

On this edition of Cancer Connection, we’ll talk about the prognosis, treatment and outlook for pancreatic cancer, America’s fourth leading killer among cancers.

Host: Thanks for downloading this podcast from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis. I’m Jason Merrill. Pancreatic cancer kills over 30,000 Americans annually, and if it isn’t diagnosed early, most patients die within seven months. Still, advances have been made surgically to reduce the mortality rate dramatically, and research into drugs and genetics gives increased hope for the future. Joining us to talk about pancreatic cancer is Stephen Strasberg. Dr. Strasberg is Pruitt Professor of Surgery and chief of the section of pancreatic and gastrointestinal surgery at Washington University School of Medicine and the Siteman Cancer Center. Dr. Strasberg, thanks for joining us.

Strasberg: You’re welcome.

Host: Pancreatic cancer isn’t necessarily a death sentence, is it?

Strasberg: No, that’s correct, it’s not. In fact, results for treatment of pancreatic cancer are improving yearly. At one time, the number of patients who were getting pancreatic cancer was roughly equal to the number of people who were dying of it, but in the last few years, we’ve seen a remarkable improvement in results so that the number of people who are dying with pancreatic cancer is far fewer than the number of people who are getting pancreatic cancer.

I should also mention one other thing in that there’s more than one kind of pancreatic cancer. There’s a pancreatic cancer that arises in the part of the pancreas that makes hormones, and there’s a pancreatic cancer that arises in the part of the pancreas that makes enzymes. The one that arises in the part of the pancreas that makes hormones has got a much better outlook.

Host: What should people know as far as warning signs for pancreatic cancer?

Strasberg: Well the pancreas is a long organ that stretches across the upper abdomen from right to left, so it depends a little bit upon where the pancreatic cancer is. But as far as the symptoms of pancreatic cancer, some of the warning symptoms can be loss of weight, jaundice, onset of diabetes, new onset of diabetes in a person over the age of 50, digestive upsets and change in the appearance or number of bowel movements a day. Those are the main symptoms that a person should look for.

Host: So if someone is diagnosed, what’s the typical course of treatment?

Strasberg: Well, once a patient is diagnosed, then they have to be staged. We have to find out where the pancreatic cancer is. If the pancreatic cancer is confined to the pancreas and it hasn’t spread to other organs, then surgery is the best option, and it is a potentially curative option. If the cancer has already spread to other organs, then the first-line treatment would be chemotherapy.

Host: So you mentioned surgery. The Whipple procedure is the surgery most commonly associated with pancreatic cancer. Talk about that surgery.

Strasberg: Yes, well the Whipple procedure is a procedure for cancer of the head of the pancreas. If you think of the pancreas, it kind of has the shape of a fish, so it has a head and a body and a tail. The Whipple procedure is the operation for the head of the pancreas. The head is the biggest part, and most of the cancers form in the head. In that operation, the head of the pancreas is removed. The head of the pancreas is sort of a railroad terminus for a number of other structures, such as the bile duct and the duodenum, so that it’s a fairly large operation. The cancer has to be removed in its entirety, and in order to do that, the duodenum and the lower end of the bile duct have to removed also, and then everything else has to be joined back together again. So it’s a big procedure. It’s a highly specialized procedure. And it’s best to have that kind of procedure done in a place where a lot of them are done.

Now as far as cancer in the body of the pancreas, we’ve made a lot of technical improvements in that area recently. We here at Washington University have introduced a new operation for cancer in that part of the pancreas called a RAMPS, and it’s specifically designed to deal with cancers of the body and tail of the pancreas. Those are the two main operations. Occasionally it’s necessary to remove the whole pancreas, but that’s not very common. It only amounts to about one in 20 operations that are done for pancreatic cancers.

Host: At one time, the mortality rates for Whipple surgery were around 20 percent, and you and your colleagues at Washington University were at the forefront of dramatically reducing those mortality rates, correct?

Strasberg: Yes, we’ve worked very hard over the past 25 years or so to improve the early results of this operation. As I said before, it’s a very large operation. There are many steps in it, and the reconstruction is technically difficult. But the mortality rates have gone from about 15 percent 25 years ago to about 1 percent today if the operation is done in a high-volume center, that is a center that’s doing a large number of these. We do approximately 100 or 110 a year at this point, so we have a very high volume, and our mortality rate is down around 1 percent.

Host: What research are you doing at the Siteman Cancer Center right now that patients should know about?

Strasberg: So there’s a significant amount of basic research going on trying to understand why cancers form in the first place, and pancreatic cancer is certainly one of those models. There’s also a lot of research going on in trying to detect cancer at an early stage. One of our colleagues in the HPB (hepatobiliary) section, Dr. David Linehan, is looking at an area called proteomics in order to try to find cancer of the pancreas at an early stage. And we’re doing basic studies in trying to understand how to destroy the cancer. We also have a number of ongoing clinical trials trying to destroy small amounts of cancer that might be left over after we remove the cancer by a Whipple procedure or a RAMPS. So there are both clinical and basic studies going on here.

Host: How important is it for people who are diagnosed to enroll in a clinical trial?

Strasberg: Well I think it is important to enroll in a clinical trial. We’re all trying to beat cancer, and particularly pancreatic cancer, together, and that’s how we advance. That’s how we learn whether a particular treatment works or not. Sometimes a clinical trial may not benefit the person who is enrolled in the clinical trial, but he or she has the knowledge that it may benefit somebody else who gets that disease in the future. Very often, however, if we’re trying a new regimen and the patient gets that regimen, it will benefit them as well.

Host: What does the future look like in treating pancreatic cancer?

Strasberg: I think the future is bright, but the timing of when the advances are going to come is difficult to predict. The reason I say the future is bright is because we are learning more and more about cancer and more and more about how to target therapy against cancer. Up until fairly recently, we were treating cancer by using drugs that were effective at killing actively growing cells. That works fairly well, but it’s not targeted to specific cancers or to specific functions of cancers. Now we are getting better and better at targeting specific functions of cancer cells so that we can destroy those cancer cells without causing a lot of collateral damage. So I feel very optimistic that in the not-too-distant future, we will have very powerful drugs, and we’ll see a huge increase in the cure rates for pancreatic cancer. We’ve already seen that in some other areas of cancer in the last few years, vast improvements in our results due to this so-called targeted therapy.

Host: Dr. Strasberg, thanks for joining us.

Strasberg: You’re welcome.

Host: For more information about pancreatic cancer, visit the Siteman Cancer Center online at www.siteman.wustl.edu or call 800-600-3606. Thanks for downloading Cancer Connection. Until next time, I’m Jason Merrill.